Breastfeeding has been a journalistic topic du jour for years now. As an author of a book about breastfeeding promotion, viagra the founder of a website supporting all methods of infant feeding, and a trained breastfeeding counselor, I read every piece on this topic with interest; after all, public perception is affected by what we see in the media, especially in today’s shareable, digital environment. It was for this reason that I was dismayed to see the interview with Arnetta Stewart and Katja Pigur of The Maternity Care Coalition (“An effort to increase breastfeeding in Philly”, 6/5/16). Not only was the piece rife with incorrect, misleading rhetoric, but it was also sadly indicative of how our society is going terribly wrong in efforts to enhance maternal/child health.

The interview begins with a discussion of breastfeeding initiation rates. While the figures used are spot-on (78% of mothers initiating breastfeeding), the hand-wringing about their inadequacy is not. These statistics do not take into account the deeply personal reasons the remaining 22% do not breastfeed from birth – women who have undergone mastectomies, women on certain contraindicated or borderline medications, and women who have histories of sexual trauma, to name a few. Also, of the many women included in this figure, how many might be second or third time mother who have learned from prior breastfeeding attempts that the practice is not possible or preferable for them? Or women who simply do not want to breasfeed, and make a fully informed choice to use formula? Seen in proper context, 78% nationwide is pretty darn impressive.

Moving on, Ms. Stewart claims that “Babies that are breast-fed are healthier babies. They have fewer infections and colds because it boosts their immunity. Breast-fed babies are less likely to be obese. The reason is if you give a baby a bottle and turn it upside down, the milk just flows out. Breast-fed babies do not overeat. Babies that drink from a bottle are overfed, and their bodies begin to recognize being overfed as the norm.”

Next, Ms. Stewart makes the mind-boggling statement that “Breast-fed babies usually speak earlier because the jaw muscles are strengthened by breast-feeding.” If there is any evidence out there to support this assertion, I haven’t come across it in 7 years in this field.
She claims that breast-feeding promotes bonding between mom and baby; perhaps in most cases, but certainly not for the women who I’ve counseled, women who despised breastfeeding or for whom the act of nursing triggered memories of sexual assault, severe physical pain, or feelings of failure. Bonding happens between two calm, connected individuals, and sometimes a bottle serves this better than the breast.

But of all the misleading claims in this piece, one stands out as particularly alarming. Says Ms. Stewart, “breast-feeding puts their children physically, mentally, and emotionally on the same playing field as moms of a higher income.” No, the way we feed our babies in the first year does not level the playing field. Better healthcare, secure and safe housing, and equal education for all begins to level it. Breastfeeding, not so much.

Breastfeeding is a human right, a healthy and empowering choice, and one that deserves support and promotion. That does not – cannot – mean over-selling its benefits or presenting it as a panacea to the real problems families face. It does not mean causing unnecessary panic for women who are unable to breastfeed with overstated blanket proclamations that mean very little on an individual basis.
The time has come for an evidence-based, culturally and emotionally sensitive discussion of infant feeding. Instead of absolutism and zealotry, we need neutral, evidence-based advocacy that put the needs and rights of both women and babies ahead of breastfeeding statistics.

In the 1993 film Groundhog’s Day, a reporter (Bill Murray) gets stuck in an endless time-warping loop, which forces him to repeat the same day over and over again. He’s aware of the constant rewinding, but no one else seems to be; everyone around him repeats the same lines and actions every day, with no knowledge that they did the very same thing the day before.

I’m starting to feel a bit like Bill Murray.

Every year or so, someone (typically a journalist or academic) writes an article for a major news outlet about the breast/bottle issue, and the universe explodes into a toxic cloud of overwrought responses and painfully long comment sections. I’m not casting stones from my glassy little house; I’ve contributed to these explosions many times by posting the catalyst articles on Facebook and Twitter, written my own overwrought responses, and added my unnecessary two cents to comment threads.

But that’s what you do, when you’re caught in a Groundhog’s Day situation. You go through the motions, say what people expect you to say. You play your part.

Here’s what my personal Groundhog’s Day looks like:

An article comes out with a controversial, negative title about breastfeeding, containing one or more of the following points:

-Breastfeeding studies are flawed and therefore can’t be trusted.

-The studies proving that breastfeeding isn’t the cat’s meow are somehow exempt from the same criticism, and can be trusted implicitly

-Everyone trying to help women breastfeed is a bully

-The person writing breastfed, but thinks formula feeding is a perfectly viable option and resents the pressure she couldn’t resist; or, she formula fed, and this is a sad, penitent story about her breastfeeding failure and how hard she tried.

Next, a response piece comes out, making one (or more) of the following arguments:

-The author of the original piece isn’t an MD or IBCLC, but rather a political or social scientist, so she’s got no business having an opinion on medical issues. (Let’s ignore that some of the most prominent voices in breastfeeding literature are anthropologists.)

-People who speak out against the pressure to breastfeed are anti-breastfeeding, hate breastfeeding mothers, and must be bitter/anti-feminist/in the pocket of Big Formula/uneducated/uninformed.

-There is no such thing as the Mommy Wars, and moms don’t really feel guilty about not breastfeeding, because our 6-month exclusive breastfeeding rates show that they are in the majority, so why would they ever feel bad?

-Because breastfeeding mothers also have problems, that negates the problems of non-breastfeeding parents.

-All of the research cited in the article means nothing, because (add circular argument here about how the AAP and WHO support breastfeeding, based on the same studies that are being questioned).

-Anyone who cares about women and babies should boycott said article and the godforsaken newspaper/website that published it.

Then, a follow up to the follow up will be written, reiterating the points of the first article, and we all act as if any part of this tone-deaf conversation is news. And so on, and so forth, until we find ourselves back at the beginning, ready to start the cycle over.

If this were a movie, I’d make a dramatic, heart-stirring speech, grab a stick, and draw a literal and proverbial line in the sand. On one side, I’d invite the the rational, kind people – regardless of their opinions on breastfeeding, or how they fed their own kids. As long as they respected other people’s points of view, and were willing to listen and have a real conversation, they would be welcome.

On the other side, we’d leave the zealots and judgmental jerks. Then something magical would happen, maybe involving a fairy godmother who’d been disguised as a gruff barkeep for the whole movie, watching and waiting for the protagonist to figure out the Big Lesson. Sparks would fly, and those of us on the “nice” side would miraculously wake up 24 hours later and go on with our lives, while the others would be stuck in that same day, having the same tired arguments. (Don’t feel bad for them. They’re happier that way.)

But there isn’t a fairy godmother, or even a barkeep, so I’m stuck reciting my lines. I’m not going to be poetic about it, because I’ve written the same article like 7000 times already and I would only plagiarize myself (is that possible?), so I’m just going to list some bullet points, in no particular order, which detail my response to the all the articles and responses and responses to responses, in no particular order:

– Breastfeeding moms struggle. They deserve help, and resources, and the right to feed their babies anywhere and in any way they see fit.

– Formula feeding parents struggle. They deserve help, and resources, and the right to feed their babies in whatever way they see fit.

– Infant feeding studies are inherently flawed. All of them. The ones that say what you want them to say, and the ones that say what you don’t. The best we have are sibling studies, of which there are approximately three. Those three do show very negligible benefits of breastfeeding. However, just because research can’t prove that breastfeeding guarantees a healthier, smarter child, does not mean it’s not worth supporting. It is still the biological norm, and there are many reasons it is worthwhile and wonderful that have nothing to do with science. (Incidentally, I find it ironic that SCIENCE is what we use to promote breastmilk, while at the same time being seriously pissed off at SCIENCE for making a damn good substitute for it. Those science-y bastards!)

– We do NOT have solid evidence that breastfeeding is the panacea (at least in western society) that organizations like WHO and UNICEF make it out to be. But remember that WHO and UNICEF are worldwide organizations, and in many parts of the world, not breastfeeding really can be a death sentence. So that might cause a bit of understandable zealotry on the subject.

– It is unfortunate that the only people speaking up about these issues are political scientists and bloggers (one exception: Dr. Amy Tuteur, who has a book coming out very soon which tackles this topic). Consider, though, that it’s basically career suicide for anyone in the medical profession to speak out against breastfeeding pressure. Until we can have more balanced discussions that don’t result in knee-jerk responses and accusations, I don’t see many practicing MDs volunteering to lead the charge. (There’s a really long discussion on this form of innate censorship in my book, not that anyone has read the damn thing. Because, you know, it’s Groundhog’s Day, and it doesn’t exist in this alternate reality. Or any reality, really, looking at my book sales. Sigh.)

– Infant feeding politics are greatly affected by region, race, class, and social group. What happens to one patient in one hospital doesn’t have much bearing on another patient in another hospital, even one down the street, let alone in a different part of the country. Some people live in breastfeeding-friendly communities where they really are the only person reaching for a bottle. The fact that their statewide statistics show that 50% of the people in their state are also reaching for bottles means nothing, unless those 50% hang out in their neighborhood, with their social circle.

– What happens in Baby Friendly Hospitals is not uniform. What Baby Friendly says in its literature can easily get lost in translation. Many, many parents report feeling bullied and pressured, and left without any resources or support once they chose to formula feed. Telling them that this isn’t happening just because it isn’t happening at the hospital YOU work at, is gaslighting, pure and simple.

– Likewise, just because you were treated like a criminal for asking to supplement, doesn’t mean someone else is lying when they say their child was given formula without reason or consent. Some hospitals are very breastfeeding unfriendly.

– Speaking of which, the whole reason for the huge push with breastfeeding is that for a long time, formula was the norm, and breastfeeding was discouraged. That said…I actually think a case could be made that the truly anti-breastfeeding period was about 2 decades, or about 25 years (50s-mid 70’s). Formula feeding became the norm in the 50’s, and that’s when pediatricians started telling women it was “better” to use commercial formula than their own milk. The pendulum swung the other direction in the mid-70’s (post Nestle disaster) and breastfeeding has been the “right” choice ever since. As it is currently 2015, and the pendulum has been way over on the breastfeeding side from around the early 90s, that means we’ve been pro-breast longer than we were anti-breast. This might be the reason for all the recent backlash – it’s time for another pendulum swing, this time (hopefully) towards the middle.

– Instead of questioning the quality of the breastfeeding research, why aren’t we questioning why we’re still doing meaningless observational studies which do nothing but frame infant feeding (and therefore, necessarily, women’s bodies) as the only element in childhood health and development? Instead, we could be using the money, time and energy finding better alternatives for those who can’t make breastfeeding work, or finding ways to support breastfeeding without harming the psyches of new mothers or marginalizing new dads or adoptive parents. Even studies which look at the chemical composition of breastmilk would be helpful and interesting. But we know that observational studies on the long-term effects of breastfeeding are bullshit, so why do we keep doing them? Seems like an exercise in frustration, to me.

– Breastfeeding supporters (IBCLCs. CLCs, nurses) are not the enemy. I think there are fundamental flaws in the training programs and governing boards that oversee these credentials, things that make it difficult for care providers to do their jobs with empathy and sensitivity. For example, the way IBCLCs are restricted by their code of conduct makes it hard to truly support formula feeding parents, in my opinion. But for those who want to breastfeed, these professionals are a GODSEND. And many do stray from the party line and help parents feed their babies, however that may happen, end of story. Stereotyping is stereotyping, no matter which way you cut it.

– The previous point does not negate the fact that many women have been mistreated and hurt in the name of breastfeeding. The individuals and organizations that perpetuate this behavior must be held accountable, just as much as the formula companies need to be held accountable for their marketing tactics, past and present.

– Speaking of marketing, formula companies have done some god-awful things. But we must be careful not to confuse their modern, generic capitalist behavior with the sins of the past. Sending a formula sample (which can be donated to a food bank or burned at the stake, you choose) is not quite the same thing as sending fake nurses into a resource-poor nation and creating conditions that killed hundred of babies.

– The experiences of formula feeding parents are just as real, valid, and important as the experiences of breastfeeding mothers, and vice versa.

– Listen to those experiences: breastfeeding mothers talk about shame around feeding in public, attitudes towards extended breastfeeding, and a lack of practical support at the hospital. Formula feeding parents talk about shame around the entire first year of feeding, being made to feel like they are harming their children, being chastised by care providers, and having a lack of practical support at the hospital. There are problems and gaps and room for improvement on both sides. It’s not a pissing contest.

– When a new voice arises on the infant feeding debate scene, don’t immediately dismiss it. Maybe there’s a reason for all these articles – maybe there are some real issues going on here, and if we solved them, the articles would stop.

I could say more, but I’m boring myself. I hope you’re bored, too; bored of the constant back and forth, bored of defending yourself and your point of view; bored of fighting. It won’t change until the people in real positions of power – physicians, members of the AAP and WHO and numerous other medical organizations, government officials, parenting “experts” – decide to take a long, hard look at what this “debate” is doing to parents and babies, and realize that if the end goal is a happier, healthier generation, they are failing miserably.

All we can do in the meantime is take care of ourselves and those around us; to tell our stories and talk to those who are willing to listen, and explain why breastfeeding is not, and never will be, the same sort of public health issue as obesity or smoking. Some will put their hands over their ears and refuse to listen, but that’s okay. Keep talking. Force it to be a dialog instead of a lecture. Read the articles you agree with, and the ones you don’t agree with. Find people who support you, and pay it forward by supporting others.

And one day, if we’re lucky, we will all wake up in our beds and find that it’s February 3rd.

My blood pressure is rising, and I’m mid-tirade directed at my poor, innocent husband when it hits me: It must be time for a good, old fashioned, FFF news roundup.

Those of you who’ve been with me for awhile probably remember that I used to do these frequently, especially when something in the news cycle gives me a bout of psychologically-induced hives. So it may come as no surprise that I felt the urge this morning, when not one, but two frustrating pieces popped up in my news feed.

First up, we have coverage of a new study in the aptly titled “Morbidity and Mortality Weekly Report”, claiming that women are still not getting sufficient support in American hospitals for breastfeeding.

Most hospitals around the country aren’t doing a good job of helping new moms who want to breast-feed, researchers report Tuesday..Several common practices at the institutions may actually prevent moms from sticking with breast-feeding for six months — the duration thought to be most healthful for babies.

Epidemiologists at the CDC surveyed more than 80 percent of the birthing centers across the country about the support they give new moms trying to breast-feed. About half of those surveyed said they implement five of the 10 practices recommended by the World Health Organization. By comparison, only a third of hospitals were hitting that mark in 2007.

Looking at the study itself, the news is far from dire. In fact, according to the CDC report of the evidence, “nationally, hospitals implementing more than half of the Ten Steps increased from 28.7% in 2007 to 53.9% in 2013.” That’s a pretty significant jump, but the media decided to go with the story that “hospitals aren’t doing enough to support women in meeting breastfeeding goals.”

This is me, reading these articles. Not really. But it SO could have been.

But what is the real story, here, and how come no one is talking about it? What this study tells us is whether hospitals are following what they are ‘supposed’ to do to help improve breastfeeding rates. These are things like providing mandatory breastfeeding classes, holding breastfeeding support groups (or referring out to La Leche League, etc.), making sure no pacifiers are given to neonates, and outlawing the use of “unnecessary” formula supplementation – something which the NPR piece gives ample air time:

And, too often, that’s not happening. For example, about 75 percent of hospitals still give healthy babies some formula in the first days of life, even when moms say they want to breast-feed.

“Even a little bit of formula may undermine a strong start to breastfeeding,” Frieden says.

Again, let’s go back to the actual study. All it tells us is that “less progress occurred in limiting non–breast milk feeding of breastfed infants (20.6% to 26.4%)”. “Breastfed infants” means infants who start out breastfeeding, presumably. But many, many parents end up supplementing by choice or by necessity – and the study does not differentiate between these situations and the type of scenario the media is imagining, where innocent breastfed babies are stolen from their parents in the night and force-fed Enfamil.

This study is not news. This study is not, in fact, telling us anything about whether women are getting “support”, at all. It is telling us whether the number of hospitals following government guidelines for raising breastfeeding rates is going up (it is). It does not correlate that number with any increase in actual breastfeeding rates. It does not survey women and ask if they felt supported in achieving their breastfeeding goals. And it certainly does not factor in the needs or experiences of women who do not want to breastfeed, or physically can’t.

But it’s not the study I’m worried about – it’s the media’s insistence on sticking to one stale, tunnel-visioned narrative, insisting that what women need is support, but defining “support” as more control over their decisions and bodies; deciding that “supporting breastfeeding” means what one group decided it means, rather than listening to women, and asking them what would really help them achieve their goals. We end up exactly in the same place we were before: with hospitals implementing pro-breastfeeding policies and then wondering why their patients and nurses are making them so difficult to carry out. (Maybe because they aren’t the right policies, or they aren’t being implemented in the right way.)

Moving on… to a piece that could have been a nice little gift to formula consumers, something that actually made a case for better transparency in the formula industry, in the popular New York Times “Motherlode” column. If you’re not familiar with Motherlode, it usually features well-written personal essays on parenting, with the occasional news, book review, or opinion piece. Today’s column, “What Does ‘Organic’ Mean For Baby Formula”, was none of these, but rather a bizarre bit of “investigative reporting” that would have fit better over on Food Babe’s blog. The author of the piece writes:

…I began to question what, exactly, were the unexpected and confusing things I was reading on the ingredients lists.

The biggest surprise was that in many of the formulas, the main ingredient was not milk, but highly processed, refined sweeteners (often listed as organic glucose syrup solids). I generally avoid feeding refined sweeteners — even organic ones — to my children. I was even more taken aback to see how many also included ingredients one wouldn’t typically expect to find in organic food — like synthetic preservatives.

I won’t bore you with all the specifics of why formulas contain sweeteners, synthetic preservatives, and “confusing” ingredients, except to say this: companies have done their R&D to make the healthiest product possible for the lowest possible price. There may indeed be less processed or more premium ingredients available, but we don’t have any research proving that more expensive or organic formulas are any better for a child’s health, so there doesn’t seem to be justification for using materials that would raise the cost. (Note: If you do want more info on formula ingredients, visit Dr. Chad Hayes’ fantastic website).

Now, to be fair, I understand the author’s confusion; if you’re used to buying high-end organic food, the back of a formula can – organic or not – is going to be super intimidating. But it’s important to remember that the definition of organic food is simply about the sources of the ingredients:

“What is organic food? Organic food is produced by farmers who emphasize the use of renewable resources and the conservation of soil and water to enhance environmental quality for future generations. Organic meat, poultry, eggs, and dairy products come from animals that are given no antibiotics or growth hormones. Organic food is produced without using most conventional pesticides; fertilizers made with synthetic ingredients or sewage sludge; bioengineering; or ionizing radiation. Before a product can be labeled ‘organic,’ a Government-approved certifier inspects the farm where the food is grown to make sure the farmer is following all the rules necessary to meet USDA organic standards. Companies that handle or process organic food before it gets to your local supermarket or restaurant must be certified, too.”

To clarify, in organic foods, the ingredients used can’t be derived from sources using GMO, pesticides, antibiotics, and so forth. It doesn’t mean that the food is healthy or whole. You could make an organic version of a Twinkie, but it would still be a Twinkie.

Now, in the case of formula, we are talking about something healthy – but also highly processed. This is chemical food, and it should be chemical food. It is a substitute for human milk; hence, the only way it can come close to human milk is by being recreated in a lab. Every mammal creates milk specific to its species; having the primary ingredient of human infant formula be cow’s milk has to do with cow’s milk being cheap and readily available, and easy enough to alter to be suitable for human consumption; it’s not because cow’s milk is particularly good for humans, whether it comes from the udders of grass-fed cows or not.

I honestly do not want to criticize the author of the NYT piece. She sounds like a very well-intentioned mother. But I do think that an article which seems on the surface to be investigative journalism instead of an opinion piece, could be misleading to other well-intentioned parents, who will now feel that they have to pay exorbitant amounts of money to feed their children “healthy” formula:

On a friend’s advice, I began to research two formulas made in the European Union, HiPP and Holle. It seemed pretty clear: these formulas came closer to what I would expect in organic baby food. No refined, high-concentrated sweeteners. No synthetic DHA or ARA. No synthetic preservatives. HiPP says it analyzes all its agricultural projects for traces of over 1,000 different substances. The main ingredient in Holle’s formula is milk that comes from pasture-fed cows raised on biodynamic farms.

Holle and HiPP are great products. And the author’s assertion at the end of her article, that parents need better options, is spot-on. I want there to be more communication between formula manufactures and parents, so that we all understand why certain ingredients are in our babies’ food. I want there to be ample options for kids with all sorts of food sensitivities; formulas for vegans; formula for parents who care about grass-fed cows. Because that’s the beauty of using a manufactured product – it can be altered. It can evolve.

What I don’t want is fear-mongering or confusion running around, when parents are already stressed and scared about formula use. I want parents to know that while DHA/ARA is indeed hexane-extracted, that does NOT mean that any hexane remains in the DHA/ARA. I want them to know that the reason many companies don’t use lactose is not because it’s expensive, but rather because cow lactose is different than human lactose, and many babies have a hard time tolerating it. I want them to know that yes, ingredients matter, and it’s absolutely okay to care about what goes into your body and your baby’s body (not that you need my permission or anyone else’s to feel how you’re going to feel, but you know what I mean), but the formulas on the market now have been tested, highly regulated, and proven to work beautifully for the majority of babies.

Insisting that we have more choices and better consumer knowledge does not have to mean throwing the generic brand-fed baby out with the bathwater. Let’s stop and talk to the people who are creating these formulas, and not just stop at the Cornucopia Institute (because both sides are affected by very strong bias, and you need to balance one extreme with the other), as well as some totally independent, science-minded folks. Let’s aim for truth and nuance rather than absolutes and middle-class food politics.

And now, I’m going to go celebrate the Cubs securing their place in the post-season, because that’s the only news really worth talking about, anyway.

For obvious reasons, I get excited whenever the media takes notice of how formula feeding parents are feeling.

That’s what happened yesterday, when the media (and my email, Twitter and Facebook feed) exploded with the news of a new campaign meant to fight back against breastfeeding pressure, using the hashtag “#bressure”. When I first read the articles about the movement, I noticed the positive (attention to the experience of “failing” to meet breastfeeding recommendations) and ignored the references to the “brelfies”, breastfeeding photos which apparently spurred the campaign in the first place. I even sent a letter to the creators, praising them and asking if the FFF community could contribute in some way.

I’ve run a modestly large international community of formula feeding parents for the past six years, and I know several truths:

1. Formula feeders are a diverse group, just as breastfeeders are a diverse group. There are militant, intolerant formula feeding parents who truly do believe that women shouldn’t breastfeed in public, just as there are militant, intolerant breastfeeding mothers who believe formula feeders are selfish, ignorant, and useless. I wish we could vote them all off the island, but alas, such is life. The problem is that we’re letting these factions monopolize the conversation. This is EXACTLY why we started #ISupportYou, to which there was a rather vocal backlash from the intolerant/militant faction, on both sides.

2. The media loves drama. It is so much more fun to blame “brelfies” for the pain we formula feeders endure, because then the extremists come out of the woodwork and create mile-long comment sections, boosting your traffic for the next few days. It is also easier to get inflammatory quotes when nuance is ignored. Nuance doesn’t get web traffic or media attention. Trust me on that one; I speak from experience.

3. Seeing breastfeeding photos is undeniably difficult for those of us who wanted to breastfeed and couldn’t, or feel conflicted about our choices. When we’re feeling vulnerable and judged, it can definitely feel like that model/celeb/Facebook friend’s breastfeeding selfie is intentionally meant to twist the knife a little deeper. But that shouldn’t stop a mom from posting a breastfeeding photo, any more than you should refrain from posting a shot of your newborn when your second cousin is struggling with fertility issues. Both of you have the right to your feelings – your pride, her grief. (That said, there’s the social media-era problem with all of us comparing ourselves to others, posting things we’d never say to someone’s face, and basically acting like insensitive jerks every time we hit “post”.)

4. The breastfeeding selfies themselves are not the problem, but the “#breastisbest #breastfeedingmomsrule #whatsyoursuperpower hashtags can be construed as an attack on formula feeding moms. That’s not me telling you to stop doing them, just explaining why the photos might hurt your best friend who switched to formula three weeks ago. That is not me telling you that the cause of normalizing breastfeeding isn’t important, just explaining why there might be better ways to achieve the same goals without adding to the conflict. Just like this latest “bressure” video series could have had a hugely positive impact, if the impetus behind it didn’t sound like bitterness and jealousy and a who-has-it-worse competition.

5. There’s enough anger, misunderstanding, and generalization on both sides of this debate to fill several football stadiums. When the media chooses to focus on something trivial (“brelfies” – for the love of god, who though of that term) instead of the real issues, we all lose. Personally, it makes me feel like I might as well jump in my DeLorean and head back to 2008, because what the hell have I wasted the past 6 years of my life on?

6. The top reasons that formula feeders are angry, based on my totally unscientific, not-peer-reviewed but at least peer-collected research, are the following:

We are made to feel like inferior mothers by medical professionals, websites, fellow moms, lactation consultants, mommy-and-me group leaders, and the media.

We get no guidance or education on bottle feeding from professionals, and when we seek it out, we get conflicting info peppered with constant reminders of why we really should be breastfeeding, so why even bother attempting to find the best type of formula, since they’re all crap, anyway?

The reasons that breastfeeding advocates and the media give for us “failing” to meet their recommendations are so far from our lived realities, it’s hard to believe we exist in the same dimension.

Everything having to do with babies these days – from conferences to books to radio shows – focuses on breastfeeding. If bottle feeding is mentioned, it’s typically in the context of Things To Avoid At All Costs Unless You Really Have to Go Back to Work In Which Case You Should Just Pump or At Absolute Worst Use Donor Milk.

Yes, there are many breastfeeding advocates who come to troll on our pages and provoke our anger. And yes, there are formula feeders who will do the same on breastfeeding pages. Ignore these people. They do not matter. There are more of us middle-ground, moderate folks than there are of them.

While mom-to-mom cruelty is certainly a part of the problem, we know that there’s a much larger battle to fight – the battle of scientific illiteracy and paternalistic advocate-physician/researchers who are blinded by a religious belief in breastfeeding. If the bullies didn’t have certain unnamed, infamous physicians leading their charge – people who encourage the shaming and ridiculing of formula feeding parents – they wouldn’t have so much power. If society had a better understanding of the reality of infant feeding research, and could acknowledge that correlation and causation are two different animals, it would take away the fear and guilt, on ALL sides.

We just want to be equal with you. Not better. We’re not even asking you to think that formula and breastmilk are equal – that’s a question of science, of risk/benefit analysis, and individual circumstance. All we are asking is that we do not equate the type of liquid going into our children’s bellies with how much we love them, or how bonded we are with them, or how strong/capable/dedicated we are as parents.

This is not about photos. This is not about who has it worse. This is not even about breastfeeding and formula feeding, anymore. It’s about how we view motherhood as a competition, how the powers that be monopolize on this competition, and how the media loves to encourage it. Instead of focusing on brelfies or bressure, let’s get the hell off Instagram and start making an impact in our own communities, with our own friends and fellow parents. Ignore the hype, and focus on the help.

A picture tells a thousand words. But they don’t have to be negative ones.

“The longer babies breastfeed, the more they achieve in life,” proclaimed an article in The Guardian this morning. And around the world, millions of parents felt their stomachs lurch. Not because of what the study this article referenced actually said, but because they know, from experience, what this study means.

It means that we will continue to be beat over the head with “breast is best” proclamations that have fudge-all to do with our individual realities.

It means that we have to avoid social media for the next few days, unless we want to silently endure smug status updates, or be labeled “defensive formula feeders” if we dare offer an alternative point of view.

It means that those of us who are newly minted moms and dads, still anxiously watching our babies’ chests rise and fall and worrying about the color of their feces and every ounce they gain, will wonder if they should have tried harder/could have done something differently/might have chosen another path.

It means we will witness another media cycle where reporters regurgitate the same mommy-war bullshit, throwing in condescending caveats about how it’s “still a mother’s choice” whether or not she nurses her child.

It means that society is still, as always, missing the damn point.

As for the study itself…. what it means is a lot less obvious. Here is the summary:

Methods

A prospective, population-based birth cohort study of neonates was launched in 1982 in Pelotas, Brazil. Information about breastfeeding was recorded in early childhood. At 30 years of age, we studied the IQ (Wechsler Adult Intelligence Scale, 3rd version), educational attainment, and income of the participants. For the analyses, we used multiple linear regression with adjustment for ten confounding variables and the G-formula.

Findings

From June 4, 2012, to Feb 28, 2013, of the 5914 neonates enrolled, information about IQ and breastfeeding duration was available for 3493 participants. In the crude and adjusted analyses, the durations of total breastfeeding and predominant breastfeeding (breastfeeding as the main form of nutrition with some other foods) were positively associated with IQ, educational attainment, and income. We identified dose-response associations with breastfeeding duration for IQ and educational attainment. In the confounder-adjusted analysis, participants who were breastfed for 12 months or more had higher IQ scores (difference of 3·76 points, 95% CI 2·20–5·33), more years of education (0·91 years, 0·42–1·40), and higher monthly incomes (341·0 Brazilian reals, 93·8–588·3) than did those who were breastfed for less than 1 month. The results of our mediation analysis suggested that IQ was responsible for 72% of the effect on income.

Interpretation

Breastfeeding is associated with improved performance in intelligence tests 30 years later, and might have an important effect in real life, by increasing educational attainment and income in adulthood.

In laymen’s terms, these researchers interviewed a large group (3493) of 30-year-olds who were part of a larger study which began in 1983, when these folks were born. They chose these subjects based on the fact that they had a significant amount of data on their infant feeding patterns and follow-up data, and because they agreed to be interviewed for the project. They gave them IQ tests, and found that those who had been at least “primarily” breastfed for 12 months scored about 3 points higher, on average. (This doesn’t mean that every single formula-fed subject scored lower, or that every single breastfed subject scored higher – we are talking about aggregates here, not individuals.) The breastfed subjects also tended to have a little under a year more schooling and make a bit more money per year.

The researchers (and the media) claim that this is the first study to so clearly show a causal (and dose-related) relationship between nursing and intelligence/success in later life.

The critics claim that because they did not control for maternal (or paternal, for that matter) intelligence, the results are not so convincing. I agree that parental IQ is far more important than most of what they did control for, but they did at least control for a fair number of confounding factors, like socio-economic status, parental education level, income, birth weight, and so forth. They also had the advantage of using a cohort for which breastfeeding wasn’t associated with class; in other words, people across all socioeconomic groups breastfed and didn’t breastfeed, ruling out the concern that some of these positive effects would merely be associative (rich people breastfeed, rich people have better opportunities/resources, etc.).

There could very well be a correlation between those in this study who were breastfed and better outcomes in terms of IQ and success. I do have some questions, though:

1. What were the formulas like in Brazil, circa 1982?

I couldn’t find anything regarding the types of foods used as breastmilk substitutes in Brazil in 1980-1983. At best, they were the same or similar to American brands, which were somewhat different than how they are now. Not vastly so, but enough that it could potentially make a difference. (Then again, most of us were raised on these formulas and don’t seem too damaged because of it, so…. make of it what you will.) The study did not specify what these babies were eating in place of the breastmilk: properly prepared, commercial infant formula? Homemade formulas? Animal milk? This does matter. We need this info before we can begin to make assumptions about the risks of formula, because for all we know we may not even be talking about formula.

2. What, exactly, were the politics of breastfeeding in Brazil, circa 1982?

The authors talk about breastfeeding not being associated with SES in this cohort, but what did cause women to choose formula over breastfeeding, and vice versa?

According to a 2013 paper in Revista de Saude Publica, “Campaigns promoting breastfeeding began in Brazil in 1981 with the National BF Promotion Program. The 1980s was marked by significant advances in legal protection for BF, with the approval of the Brazilian Code of Marketing of Breast Milk Substitutes and the inclusion of the right to 120 days maternity leave in the Constitution.” I also found references to a Brazilian television campaign which promoted breastfeeding, initiated in the early 1980s which featured spots aimed at various demographics, using language, images and celebrities that would appeal to these specific groups. This implies that the author’s assertion that their study was able to negate possible confounding factors might be overstating it a bit. Socioeconomic status is not the only thing that could give a child a slight bump in advantages associated with success later in life. If there were fundamental differences in the mothers who chose to breastfeed back in 1983 Brazil, those differences would matter for the purposes of this study.

3. Why is a 3-point bump in IQ and a slightly higher income so important for public health, anyway?

The authors state that these findings are important on a public health and economic level. But let’s get Orwellian here, for just a second: if everyone is breastfeeding, then everyone is getting the 3-IQ point and 1-more-school-year advantage. Everyone is making more money per year. The playing field is even. I nearly failed Econ, so correct me if I’m wrong, but don’t you need “have-nots” to have “have’s”? If the whole country is smarter, then I guess you’d have an economic advantage… but the breastfeeding research world is quite international in scope. After all, our recommendations come from the World Health Organization, not the Every-Country-For-Herself Organization. If we all are smarter from breastfeeding, that’s great – but it’s not much of an economic argument, is it?

Obviously, I am being entirely facetious with the a paragraph. I am far from convinced that breastfeeding makes you smarter or more successful. But I want to point out how convoluted these arguments in favor of breastfeeding truly are. How offensive they are. The implication is that our life’s worth is measured in IQ and financial reward. How about a study showing how traits like patience, kindness, acceptance, creativity, ingenuity are tied to infant feeding?

This study was funded by public health agencies, so these questions are important. When we confuse public health messaging with messaging about IQ and “success” (a quite narrow definition of it, incidentally), we are heading down a very slippery slope.

4. Why aren’t we asking why and how, instead of droning on about the same old tired shit?

If – and this is a strong if – the author’s hypothesis that the fatty acids in breastmilk may be the cause of this bump in IQ (which they imply is what provoked the longer time in school and the greater income – again, sort of a sloppy connection, considering there’s many people with incredible IQs and low levels of education and career success), then why is the take-away “see, everyone should breastfeed!” and not “how can we improve breastmilk substitutes so that all babies get this advantage?”

The study itself is only noteworthy because it followed a lot of people over a lot of years. But remember: associative data is always associative data. Sure, larger groups make for more dramatic assumptions, but at its core, this is just like any other infant feeding study: it shows that there is a slight advantage for people who were breastfed. It doesn’t show how, it doesn’t show why, and it doesn’t tell us squat about anything on the individual level. It does not in any way prove that tour brilliant formula-fed child would have been 3 points more brilliant if you’d managed to breastfeed her. And even if it did prove without a doubt that breastfeeding added 3 points to every single baby’s IQ, it would not tell us how many IQ points a baby might lose if she was starving for the first 6 months of her life, or if her mother was crying and absent all the time, hooked up to a pump, instead of interacting with her. Or if the breastmilk she was getting was laced with any number of substances. Or if her mom didn’t eat enough kale. Or too much kale. Or if her mom ate dairy and she had an undiagnosed MSPI. Or if her dad was an asshole. Or if she was abused and dropped out of school and did drugs that dulled her senses, rendering her unable to even take the bloody IQ test.

My point is, no matter what this study tells us (and it doesn’t tell us anything we hadn’t already heard), the more important thing is what it doesn’t tell us. Life is about so much more than what you eat in the first few months of your life. That doesn’t mean it doesn’t matter – otherwise I wouldn’t be so crazy about making sure research is done to improve formulas and make sure they are as safe and healthy as possible – but provided your child us getting adequate nutrition, there are just so many other things that can help them along or trip them up.

And don’t hate me for saying this, but you are only one of them. Sure, you’re who they are going to be talking about on the therapists’s couch in 30 year’s time, but they aren’t going to be mad at you for not breastfeeding. They are going to be mad that you missed their school play, that you embarrassed them in front of the cool kids in the parking lot of the mall, that you didn’t support their life’s dream to be a potter specializing in tiny, thimble-sized pots.

So do yourself a favor: throw out the newspaper screaming about breastfed babies “growing up to smarter, richer adults”, turn off the Today Show with its smug newscasters, and talk to your child. Because that’s they want. Not your breastmilk. Not 3 IQ points. They want you, and all your imperfections, and all your concerns for their welfare and your anxieties and your dorkiness and your dysfunction. They just want you.